MEDICARE: EDWIN G. GOLDSTEIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	6891	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326037037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN G. GOLDSTEIN M.D.

Provider Business Mailing Address
First Line	:	4043 E SOLANO DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-1144
Country	:	US
Telephone Number	:	602-840-0882
Fax Number	:	602-840-0778

Provider Business Practice Location Address
First Line	:	1111 E MCDOWELL RD
Second Line	:	DEPARTMENT OF MEDICAL IMAGING, GOOD SAMARITAN HOSPITAL
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2612
Country	:	US
Telephone Number	:	602-239-4850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	05/14/2008

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